Cardiac abnormalities are among the most common and complex risk factors of pediatric acute ischemic stroke (AIS). Although endovascular treatment (EVT) is increasingly used in children, uncertainty persists regarding its safety and effectiveness in patients with underlying cardiac disease, leading to therapeutic hesitation in this high-risk population. The aim of this study was to determine whether the association between EVT and functional outcomes after pediatric AIS differs according to cardiac abnormality status.

This study was a retrospective secondary analysis of a prospective, multinational cohort registry (Save ChildS Pro). The registry enrolled patients between 2018 and 2023, with 90-day follow-up. Participants included children aged 28 days to 18 years with confirmed AIS due to large vessel occlusion and available 90-day Pediatric Stroke Outcome Measure (PSOM) scores. Cardiac abnormalities were defined as congenital or acquired cardiac disease documented by echocardiography or medical records. The primary outcome was poor functional outcome at 90 days, defined as PSOM score >0.5. Secondary outcomes included ordinal 90-day modified Rankin Scale (mRS) scores and longitudinal neurologic recovery assessed using the Pediatric NIH Stroke Scale (pedNIHSS). Treatment-subgroup interaction was assessed using penalized logistic regression.

Of 208 eligible patients, 178 were included in the final analysis after excluding those with missing outcome data [43% female; mean age: 11.5 years]. Among 178 children, 56 (31.5%) had cardiac abnormalities. EVT was more frequently performed in children with cardiac abnormalities than in those without (p = 0.003). Cardiac abnormality status was not independently associated with outcome (odds ratio, 0.93; 95% CI, 0.36-2.52), and no significant interaction between EVT and cardiac abnormality was observed. Ordinal mRS shift analysis and longitudinal pedNIHSS modeling supported similar recovery trajectories. Adverse event rates did not differ by EVT status in either subgroup.

In this multinational pediatric AIS cohort, EVT was associated with improved functional outcomes and accelerated neurologic recovery, with no evidence that cardiac abnormality status modifies association of treatment with outcome or safety. These findings support consideration of EVT in children with cardiac abnormalities when clinically indicated.

This study provides class IV evidence that endovascular therapy in pediatric patients with AIS is associated with improved functional outcome irrespective of underlying cardiac abnormality status.

Plasma glial fibrillary acidic protein (GFAP), a marker of astrocyte reactivity, is elevated across multiple neurodegenerative conditions, including Alzheimer disease. However, its role in neurodegeneration and cognitive decline driven by cerebrovascular pathology, independent of β-amyloid (Aβ) copathology, remains poorly characterized. We investigated whether plasma GFAP is associated with medial temporal atrophy and cognition across a spectrum of cerebrovascular burden in Aβ-negative cognitively impaired individuals.

In this cross-sectional multicenter study, Aβ PET-negative cognitively impaired participants were recruited from South Korean memory clinics. Plasma GFAP was measured using ultrasensitive Simoa assays. White matter hyperintensity burden was graded using the Fazekas scale and stratified into low (LVP: Fazekas 1) and high (HVP: Fazekas 2-3) cerebrovascular burden groups. Medial temporal gray matter density was assessed using voxel-based morphometry, and hippocampal and amygdalar volumes were derived from T1-weighted MRI adjusted for intracranial volume. Linear regression, interaction, and bootstrap mediation models were used to assess associations among GFAP, brain structure, and cognition.

A total of 324 participants were included (LVP n = 203; HVP n = 121; median age 73 years [interquartile range 66-78]; 67.9% female). Compared with LVP, HVP participants were older (75 vs 71 years; p < 0.0001), had lower Mini-Mental State Examination (MMSE) scores (22.7 vs 24.5; p = 0.005), and higher plasma GFAP (136.7 vs 112.1 pg/mL; p = 0.001). Higher GFAP was associated with lower medial temporal gray matter density in HVP (β = -0.311; p = 0.001) but not LVP (β = -0.012; p = 0.858), with a significant GFAP-vascular burden interaction (β = -0.309; p = 0.008). In HVP, higher GFAP was associated with smaller hippocampal (β = -0.179; p = 0.044) and amygdalar volumes (β = -0.169; p = 0.049) and lower MMSE (β = -0.194; p = 0.039). Medial temporal atrophy statistically explained the GFAP-MMSE association (indirect β = -0.071, 95% CI -0.140 to -0.010; p = 0.016). Vascular comorbidities (diabetes, dyslipidemia, hypertension) did not modify the GFAP-cognition association.

In Aβ-negative cognitively impaired individuals with high cerebrovascular burden, elevated plasma GFAP is associated with medial temporal atrophy and cognitive decline, suggesting GFAP may capture astrocyte-reactivity relevant to vascular cognitive impairment beyond amyloid pathology. These cross-sectional findings require confirmation in longitudinal and ethnically diverse cohorts.

Atherosclerosis (AS) is closely linked to endothelial cell (EC) senescence and mitochondrial dysfunction, which impair vascular repair. Resveratrol (RSV) has antioxidant, anti-inflammatory, and pro-angiogenic effects, but its clinical use is restricted by poor bioavailability. This study aimed to construct a platelet membrane-coated resveratrol nanosystem (PM@RSV NPs) and investigate its mechanism of action in delaying the progression of AS by activating FOXM1 to improve mitochondrial function, inhibit EC senescence, and promote vascular regeneration. PM@RSV NPs were prepared using a solvent evaporation method combined with membrane-coating technology, and gene expression profiles and key regulatory networks were analyzed through RNA sequencing (RNA-seq), gene set enrichment analysis (GSEA), and least absolute shrinkage and selection operator (LASSO) regression. In vitro, PM@RSV NPs enhanced mitochondrial membrane potential and ATP generation while decreasing ROS accumulation and the number of SA-β-Gal-positive cells, accompanied by FOXM1 upregulation in ECs. In vivo experiments demonstrated that PM@RSV NPs significantly reduced plaque area, improved mitochondrial function, decreased levels of senescence markers, and promoted vascular regeneration via FOXM1 regulation. In addition, PM@RSV NPs preferentially accumulated in ox-LDL-injured MAECs and AS lesion-associated vascular endothelium, mainly through platelet-membrane adhesion proteins such as GPV and P-selectin; their biosafety was evaluated by EC viability/apoptosis assays, histological examination of major organs, and serum biochemical indices of liver and kidney function. This study confirmed that PM@RSV NPs improved mitochondrial function, inhibited endothelial senescence, and enhanced vascular regeneration by activating FOXM1, offering a novel therapeutic strategy for treating AS.

Organised stroke care and reperfusion therapies are key components of modern stroke treatment. We assessed accessibility of organised stroke care and reperfusion therapies in Europe and explored its association with key organisational indicators.

Stroke Action Plan for Europe (SAP-E) Stroke Service Tracker data from 2023 reported by 47 European countries was assessed. Accessibility indicators included stroke unit (SU) admission proportions, intravenous thrombolysis (IVT) and EVT treatment proportions. Organisational indicators included the facility density of SU, IVT-capable centres and EVT-capable centres per capita (number of centres per 100,000 population), presence of national stroke plans and quality programmes.

Across Europe, marked variations were observed in facility density of SU (0.21-0.48), IVT-capable centres (0.19-0.45) and EVT-capable centres (0.06-0.15). SU admission proportions ranked from 0.8% to 96.7%, IVT treatment proportions from 1.3% to 34.7% and EVT treatment proportions from 0.2% to 14.3%. Stroke unit admission proportions were associated with SU density (r = 0.42, P = .03). Density of reperfusion-capable centres showed a possible trending association with IVT treatment proportions (r = 0.34, P = .08), but no association with EVT treatment proportions (r = 0.22, P = .23). Neither the presence of a national stroke plan nor a quality programme were associated with accessibility of SU care, IVT or EVT.

Large inequities in access to organised stroke care and reperfusion therapies persist across Europe. At the country level, national stroke plans and quality programmes have not yet translated into effect on accessibility indicators, suggesting that achieving effective implementation takes time or could primarily manifest as within-country improvements.

Atrial fibrillation (AF) burden, the time spent in AF, is increasingly investigated. Data on its characteristics and temporal patterns during early in-hospital telemetry after ischaemic stroke remain limited.

Continuous ECG telemetry was analysed in consecutive patients with MRI-confirmed ischaemic stroke and AF admitted between October 2020 and January 2023 in this observational retrospective cohort trial. Peak AF burden within any 24-h window was categorised as low (≤1 h), medium (>1-6 h), high (> 6 h) or no recorded AF episodes. Associations with clinical and imaging features were assessed using multivariable regression.

Among 392 patients with AF-related stroke (median monitoring duration 68 h, median AF burden 12.0 h), AF burden was low in 30 (7.7%), medium in 68 (17.3%), high in 193 (49.2%) and 101 (25.8%) had no recorded episodes. Left-insular stroke was negatively associated with high AF burden (aOR 0.38, 95% CI, 0.15-0.84, P < .05). There was a signal towards a positive association with right-insular stroke (aOR 1.75, 95% CI, 0.90-3.41, P = .09). The laterality difference persisted in continuous-scale analyses. First AF episodes clustered in the early evening among low-burden patients, with early morning episodes least common across all groups. Among patients with known stroke onset (n = 102), 49 exhibited AF confined to the first 48 h.

AF burden varies widely during early in-hospital monitoring after ischaemic stroke and seems to differ according to insular lesion laterality. Our findings are hypothesis-generating and highlight the need for integrating lesion location, circadian and arrhythmia dynamics to characterise AF burden after stroke.

The burden of ischaemic stroke in Europe has evolved over recent decades, shaped by changes in prevention, acute care and population ageing. Understanding long-term trends in mortality and disability is essential for guiding policy and service planning.

Using Global Burden of Disease (GBD) 2023 estimates, we analysed age-standardised disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) for ischaemic stroke across all European countries from 1990 to 2023. We estimated country-specific annual percentage changes (EAPCs), assessed non-linear trajectories, examined shifts in the fatal vs non-fatal composition of DALYs and synthesised trends using mixed-effects models and descriptive meta-analytic pooling.

Disability-adjusted life year rates declined in every European country, with the steepest reductions in Central and Western Europe and more modest improvements in parts of Eastern and Southeastern Europe. Years of life lost declines closely paralleled DALY trends, indicating that falling premature mortality was the main driver of the overall reduction. Years lived with disability trends were smaller and more heterogeneous across countries. Mixed-effects modelling indicated average European EAPCs of -3.40% (95% CI, -3.74 to -3.05) for DALYs, -1.26% (-1.43 to -1.09) for YLLs and -3.86% (-4.26 to -3.46) for YLDs. Meta-analytic pooling of national patterns showed large declines in YLLs (random-effects EAPC -3.81%) relative to YLDs (-0.86%).

Ischaemic stroke burden has fallen substantially across Europe, driven primarily by reductions in premature mortality. Slower progress in disability outcomes and persistent regional disparities highlight the need to strengthen long-term rehabilitation and address uneven improvements across the continent.

Women with adverse pregnancy outcomes have higher subsequent cardiovascular risks, but their long-term risks of peripheral artery disease (PAD) and potential causality are unclear. A better understanding of such risks is needed to improve early risk stratification, clinical care, and long-term cardiovascular health. We sought to determine long-term risks of PAD associated with 5 major adverse pregnancy outcomes in a large population-based cohort, and to assess for familial confounding using co-sibling analyses.

A national cohort study was conducted of all 2,201,446 women with a singleton delivery in Sweden in 1973-2015, followed up for PAD identified from nationwide inpatient and outpatient diagnoses linked through 2018. Cox regression was used to compute hazard ratios (HRs) for PAD associated with preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes, adjusting for other maternal factors (age, year of delivery, parity, socioeconomic factors, body mass index, smoking, and prior history of hypertension, diabetes, or hyperlipidemia). Co-sibling analyses assessed for potential confounding by shared familial (genetic and/or environmental) factors. In 54 million person-years of follow-up, 13,211 (0.6%) women were diagnosed with PAD (median age, 62 years). All adverse pregnancy outcomes were associated with significantly increased long-term risk of PAD. At 30-46 years following delivery, adjusted HRs for PAD associated with specific adverse pregnancy outcomes were: gestational diabetes, 3.83 (95% CI [3.20,4.59]; p < 0.001); small for gestational age, 1.74 (95% CI [1.65,1.83]; p < 0.001); other hypertensive disorders, 1.61 (95% CI [1.21,2.15]; p = 0.001); preterm delivery, 1.58 (95% CI [1.48,1.70]; p < 0.001); and preeclampsia, 1.28 (95% CI [1.20,1.37]; p < 0.001). These findings were largely unexplained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk. This study was limited to Sweden and will need replication in other populations, and was based on diagnostic codes which may involve some misclassification.

In this large national cohort, all adverse pregnancy outcomes were associated with increased risk for PAD up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical follow-up to reduce their risk of PAD and other associated cardiovascular diseases.

Patients undergoing metabolic bariatric surgery are at risk of both venous thromboembolism (VTE) and bleeding complications, but the optimal thromboprophylaxis strategy remains uncertain. Therefore, this retrospective cohort study evaluated perioperative outcomes depending on the perioperative thromboprophylaxis strategy.

This study used data from the validated nationwide Scandinavian Obesity Surgery Registry, including all primary bariatric procedures in Sweden between 2008 and 2023. Exposures were timing of initiation (preoperative, postoperative, other) and the duration of thromboprophylaxis (< 7, 7-10, 11-14, or > 14 days). The primary outcome was VTE; secondary outcomes were intraoperative and postoperative bleeding. Outcomes were analysed using logistic regression models, adjusting for demographic, clinical, and surgical covariates.

Among 83 801 patients (76.9% female, mean age 40.9 years, mean body mass index 41.8 kg/m2), the incidences of VTE, intraoperative bleeding, and postoperative bleeding were 0.1% (76 patients), 0.7% (577), and 1.6% (1373), respectively. No statistically significant associations were observed between the timing of thromboprophylaxis and VTE, or between thromboprophylaxis duration and either VTE or postoperative bleeding. Initiation of prophylaxis after surgery was associated with a lower risk of intraoperative bleeding than preoperative initiation (odds ratio 0.52; 95% confidence interval 0.37 to 0.74). Risk factors for VTE included previous VTE, intraoperative bleeding, and longer operating time, whereas risk factors for postoperative bleeding included higher age, male sex, cardiovascular co-morbidity, and antidepressant use.

The overall incidence of thrombotic complications after metabolic bariatric surgery was low, whereas bleeding events were more common. Compared with preoperative thromboprophylaxis initiation, postoperative initiation was associated with reduced intraoperative bleeding, whereas no increase in VTE was detected.

Non-alcoholic fatty liver disease (NAFLD) is a global public health crisis linked to elevated all-cause and cardiovascular mortality. The neutrophil-to-high-density lipoprotein ratio (NHR) is an emerging inflammatory-lipid biomarker that integrates systemic inflammation and lipid dysregulation. However, its prognostic value for long-term mortality in NAFLD remains undetermined.

We conducted a population-based prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. A total of 5,320 participants diagnosed with NAFLD were enrolled and divided into four groups according to quartiles of NHR (Q1-Q4). Multivariate Cox regression, restricted cubic spline, threshold effect, and subgroup analyses were used to evaluate the association between NHR and all-cause mortality.

During a mean follow-up of 9.2 years, 1,172 all-cause deaths and 392 cardiovascular disease (CVD) deaths were documented. In the fully adjusted Cox models, higher NHR was significantly associated with elevated risks of all-cause mortality (HR = 1.27, 95% CI: 1.02-1.57) and CVD mortality (HR = 2.15, 95% CI: 1.44-3.22) in a dose-response manner, but not with cancer mortality. Further adjustment for blood lipids and hepatic function markers did not materially alter the results, supporting the robustness of the observed associations. Threshold and spline analyses further revealed a significant nonlinear relationship between NHR and all-cause mortality, with an inflection point of 2.072, when NHR was equal to or above 2.072, each 1-unit increase was associated with an 8% elevation in all-cause mortality risk (HR = 1.08, 95% CI: 1.04-1.12, P < 0.001). Subgroup stratified analyses were performed as exploratory analyses. Although the association between elevated NHR and all-cause mortality reached statistical significance within several individual subgroups, no significant multiplicative interaction was detected for any stratifying factor, indicating no meaningful effect modification across these population strata.

Elevated NHR is independently associated with an increased risk of all-cause and cardiovascular mortality in NAFLD patients. NHR may serve as a simple, inexpensive, and readily available prognostic biomarker for risk stratification and clinical management in this population.

Family health resources are critical elements for rural households to withstand health shocks. However, the mechanisms through which these resources are linked to the economic risk of diseases remain unclear. Grounded in the Conservation of Resources (COR) theory, this study investigates the association of family health resources with the economic risk of diseases among rural households.

Utilizing data from the 2020 wave of the China Family Panel Studies (CFPS), the economic risk of diseases was quantified using the Three-Stage Feasible Generalized Least Squares (FGLS) method. Path analysis was employed to examine the direct effects and the mediating roles.

The average score of family health resources among rural households was 3.34 ± 0.73. A total of 400 households (9.42%) were identified as high-risk. Family health resources significantly predicted a significantly lower economic risk of diseases (P < 0.001). Mechanism analysis revealed that resource quantity is associated with economic risk through three mediating functions: positive effects from accumulation and investment function, and a negative effect from compensation function.The mediation effects of these three functions accounted for 12.492%, 2.580%, 7.196% of the total effect, respectively. Compared to overall resource-disadvantaged households, the resource-balanced advantaged households demonstrated stronger mediation proportions through the accumulation function and investment function-29.774% and 9.548%, respectively.

Family health resources are negatively associated with the economic risk of diseases by promoting the accumulation and investment functions while a lower reliance on the compensation function. Targeted optimization of family health resource allocation is needed to strengthen resilience against disease-related economic risk.